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Always Clarify

Always Clarify. Session Two-Part Two. 3 Readings 3.1 Two contrasting world views 3.1.1 Christian approaches 3.2 Robert Orr’s method 3.3 Common secular approaches 3.4 Bioethics: a tragic view. 3.1 Two contrasting worldviews. Judeo-Christianity Darwinian Naturalism. Image of God.

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Always Clarify

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  1. Always Clarify

  2. Session Two-Part Two • 3 Readings • 3.1 Two contrasting world views • 3.1.1 Christian approaches • 3.2 Robert Orr’s method • 3.3 Common secular approaches • 3.4 Bioethics: a tragic view

  3. 3.1 Two contrasting worldviews • Judeo-Christianity • Darwinian Naturalism

  4. Image of God • Genesis 1:27 27 God created man in His own image, in the image of God He created him; male and female He created them. • 2 Peter 1:4 For by these He has granted to us His precious and magnificent promises, so that by them you may become partakers of the divine nature,

  5. Image of God-Substantive Genesis 2:7 And the LORD God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became living soul.

  6. Pre-Conscious • Naïve state prior to stimulus challenge

  7. Sub-conscious • Sense or unarticulable feeling

  8. Image of God- Conscious • Conscious state

  9. Image of God-Relational & Functional- Gen. 1:28-31

  10. Sanctity and Quality of Life • Absolute Sanctity of Life • Qualified Sanctity of Life • Transcendental Sanctity of Life • Pure Quality of Life “Saying the Unsaid: Voicing Quality of Life Criteria in a Sanctity of Life Position," in The Journal of the Evangelical Theological Society. (March 1996) v. 39/1, pp. 103-122

  11. tSOL/QoL Criteria • Imminent Death • Irreparable Condition • Irreversible Condition

  12. tSOL& a Theology of Martyrdom • Philippians 1:21 For to me, to live is Christ and to die is gain. • Philippians 1:23-24 But I am hard-pressed from both directions, having the desire to depart and be with Christ, for that is very much better; yet to remain on in the flesh is more necessary for your sake. • Romans 14:8 for if we live, we live for the Lord, or if we die, we die for the Lord; therefore whether we live or die, we are the Lord's.

  13. The Fall • Genesis 2:9 Out of the ground the LORD God caused to grow every tree that is pleasing to the sight and good for food; the tree of life also in the midst of the garden, and the tree of the knowledge of good and evil. • Genesis 3:5 "For God knows that in the day you eat from it your eyes will be opened, and you will be like God, knowing good and evil."

  14. ∞ ∞ Horizon of YHWH Truth & Illusion Kingdom of the Knowledge of Good and Evil Object/Phenomena/Appearance (Structure of Sin) Fact & Symbol I in Incarnational Community of Contrast other Communal Spiritual Narrative Emergence Kairos Futurity-Eternal Futurity- Temporal Heilsgeschichte Spiritual Illumination Kingdom of Life Age of ages Aeveternity Spiritual Ex-ist-ance (Essence, Noumena, Thing-in-Itself) (Father/Logos/Spirit) YHWH ∞ ∞

  15. The Good God Question • Job 38:1-2 Then the LORD answered Job out of the whirlwind and said, 2 "Who is this that darkens counsel By words without knowledge? • Job 42:3 'Who is this that hides counsel without knowledge?' "Therefore I have declared that which I did not understand, Things too wonderful for me, which I did not know."

  16. 3.1.1 Christian Approaches • Roman Catholic based principlism1 • Judeo-Christian Hippocratic ethics • Christian Virtue Ethics 1Ethical and Religious Directives for Catholic Health Care Services Fifth Edition. United States Conference of Catholic Bishops, Issued by USCCB, November 17, 2009

  17. 3.2 Robert Orr’s Method • Framing the medico-ethics question • Four elements for medical clarification • Clarifying decision making agency • Clarifying institutional level issues • Operative norms and values • Discussion • Recommendations • Follow-up • Comments

  18. 3.2.1 Framing the Medico-ethics Question

  19. 3.2.2 Four elements for medical clarification • Patient History • Diagnosis • Prognosis • Treatment plan

  20. 3.2.3 Clarifying decision making agency • Patient capacity • Legal competency • Surrogate agency

  21. 3.2.4 Clarifying institutional level issues • Distinctives in policy and procedure • Legal implications

  22. 3.2.5 Operative norms and values • Primary agents • Mitigating agents

  23. 3.2.6 Discussion

  24. 3.2.7 Recommendations

  25. 3.2.8 Follow-up and Comments

  26. 3.3 Darwinian Naturalism • Principlism • Social Contract

  27. Variation on Principlism • Medical indication (medical norms) • Patient Preference (autonomy) • Quality of life (Beneficence/non maleficence) • Contextual features (includes justice) Albert Jonson: Clinical Ethics

  28. Social Contract • Contracts made with voluntarily consent to receive or give up benefits and burdens to its members, health care institutions and health care distributions must conform to the dictates of agree upon principles • Equitable distribution of health care should be conceived in terms of justice • Done under the ‘veil of ignorance’ • Mini/max principle

  29. The proper way to think abut health-care spending is to focus on the NET SOCIAL VALUE ADDED by health care, defined as: Net Social Gross Value The Opportunity Value Added = Added by - pp y Costs of that b th H lth y by the Health Health Care to Care for Society S t P ti t y System Patients Among these opportunity costs are: • The education of our young • Basic science and R&D • The nation’s public infrastructure • National security andthe safety of our warriors The proper way to think abut health-care spending is tofocus on the NET SOCIAL VALUE ADDED by health care,defined as: • Among these opportunity costs are: • education of our young • basic science R&D • nation’s public infra-structure • national security and defense David B. Reuben: Portland Providence Medical Center Grand Rounds Providence Nov. 16, 2011

  30. A Matrix for Ethical DecisionMaking in a PandemicDr. John Tuohey An Example of Applied Synthesis of Principlism and Social Contract

  31. Ethics Exercise • Interactive Exercise • Orr’s Method

  32. Clinical Ethicist Interview • How did you prepare to be a clinical ethicist? • What is the policy and procedure for a clinical ethics consult? • How do you approach conflict? • Is there ever a place is their for a local spiritual counselor in a clinical ethics consult? • How would you counsel me to respond if I were called to be involved in a case?

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